Home Healthcare Use Differences Depending on Birth Places and Living Arrangements Among Older Adults

Culturally created filial obligations are strong indicators of racial/ethnic groups’ decisions on whether to care for their elderly parents. However, an aspiration-actual practice gap exists in fulfilling filial obligations toward caring for elderly parents. As for this gap, some studies have argued that familial care to elderly parents may become weak (‘crowding-out’ family solidarity) in well-developed welfare systems while the opposite (‘crowding-in’ family solidarity) may occur in less-developed welfare systems (Silverstein & Wang, 2015). Meanwhile, Künemund and Rein (1999) argued that, even in well-developed welfare systems, both crowding-in and crowding-out may occur depending on the welfare programs available for the elderly and the relationships between the elderly and their children. The Balanced Budget Act of 1997 capped Medicare coverage for homecare services, resulting in a decrease in homecare provisions. However, a lack of empirical research on immigrant elders’ (65+) homecare use exists. Hence, we examine the extent to which their homecare use differs depending on birthplaces and living arrangements and interaction effects of birthplaces and living arrangements.

Methods.

Using National Health Information Survey data (2002-2013), the potential interaction effects between living structure (living alone, co-residence with adult(s) and children, and co-residence with adult(s) only) and birthplaces (11 birthplaces including USA) were examined in logistic regression analyses in regard to homecare use while controlling for the effects of healthcare needs and region. Then, post-hoc probing examined the behaviors of the significant interactions.

Results.

Homecare use had significant and positive associations with Medicare, Medicaid, income, age, and female, but negative associations with private insurance. Immigrants were more likely than natives to use homecare services (p=0.01). Significant interaction effects existed between co-residence with adult(s) and children and immigrant status (p<0.01). Post-hoc probing revealed that immigrants tended not to use homecare services when they co-resided with adult(s) and children.

Related to birthplaces, homecare use had positive relationships with Mexico (p<0.001) and Russia (p<0.1) and negative relationships with Asia (p<0.01). Co-residence with adult(s) and children interacted with Mexico (p<0.01), Russia (p<0.001), and Indian subcontinents (p<0.05). Post-hoc probing revealed that these racial/ethnic groups’ homecare use behaviors in relation to living arrangement were not identical: Russian and Indian subcontinent elders tended not to use homecare services when they co-resided with adult(s) and children; however, Mexican elders tended to use the services when they co-resided with adult(s) and children.

Conclusions.

Consistent with previous research, we found that older adults who co-resided with adult(s) depended on informal support, suggesting ‘crowding-in’ family solidarity under the restrictive Medicare policy to homecare services. However, we highlight that dissimilarities in homecare use existed among Africans, Mexicans, and Asians although the literature described strong filial obligations for elderly parents among these groups and more aspirations for informal care for their elderly parents. Unlike other racial/ethnic groups, Mexican elders tended to use more homecare services than U.S.-born elders and their homecare use was also greater when they co-resided with adult(s) and children than when they lived alone. Future research should examine which factors make Mexican immigrant elders’ homecare use differ from other racial/ethnic minorities’ use.